Biomarkers of Atrial Fibrillation in Hypertension

2019 ◽  
Vol 26 (5) ◽  
pp. 888-897 ◽  
Author(s):  
Costas Tsioufis ◽  
Dimitris Konstantinidis ◽  
Ilias Nikolakopoulos ◽  
Evi Vemmou ◽  
Theodoros Kalos ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Ventricular ◽  
P Wave ◽  
Diagnostic Tools ◽  
Atrial Remodeling ◽  
Hypertensive Patients ◽  
Risk Patients ◽  
Underlying Mechanisms ◽  
Prompt Diagnosis ◽  
The Ideal

Background: Atrial fibrillation (AF) is the most frequently encountered cardiac arrhythmia globally and substantially increases the risk for thromboembolic disease. Albeit, 20% of all cases of AF remain undiagnosed. On the other hand, hypertension amplifies the risk for both AF occurrences through hemodynamic and non-hemodynamic mechanisms and cerebrovascular ischemia. Under this prism, prompt diagnosis of undetected AF in hypertensive patients is of pivotal importance. Method: We conducted a review of the literature for studies with biomarkers that could be used in AF diagnosis as well as in predicting the transition of paroxysmal AF to sustained AF, especially in hypertensive patients. Results: Potential biomarkers for AF can be broadly categorized into electrophysiological, morphological and molecular markers that reflect the underlying mechanisms of adverse atrial remodeling. We focused on P-wave duration and dispersion as electrophysiological markers, and left atrial (LA) and LA appendage size, atrial fibrosis, left ventricular hypertrophy and aortic stiffness as structural biomarkers, respectively. The heterogeneous group of molecular biomarkers of AF encompasses products of the neurohormonal cascade, including NT-pro BNP, BNP, MR-pro ANP, polymorphisms of the ACE and convertases such as corin and furin. In addition, soluble biomarkers of inflammation (i.e. CRP, IL-6) and fibrosis (i.e. TGF-1 and matrix metalloproteinases) were assessed for predicting AF. Conclusion: The reviewed individual biomarkers might be a valuable addition to current diagnostic tools but the ideal candidate is expected to combine multiple indices of atrial remodeling in order to effectively detect both AF and adverse characteristics of high risk patients with hypertension.

Tedisamil in Coronary Disease: Additional Benefits in the Therapy of Atrial Fibrillation?

2003 ◽  
Vol 8 (1_suppl) ◽  
pp. S33-S37 ◽  
Author(s):  
Lionel H. Opie
Keyword(s):  
Atrial Fibrillation ◽  
Ventricular Hypertrophy ◽  
Oxygen Demand ◽  
Outward Current ◽  
Left Ventricular ◽  
Ventricular Rate ◽  
Transient Outward Current ◽  
Atrial Remodeling ◽  
Atrial Rhythm ◽  
The Ideal

Atrial fibrillation has recently come into clinical and research focus. In particular, ventricular rate control has been carefully compared with atrial rhythm control. Additionally, the recent discovery of atrial stunning has initiated clinical and research interest in atrial remodeling. Atrial fibrillation is more likely to occur when the atria are damaged by increased fibrosis. The ideal way to prevent atrial fibrillation and the risk of repetition is by tackling the root causes, such as ischemic heart disease, heart failure, and left ventricular hypertrophy. Tedisamil is an unusual antifibrillatory compound that has a novel mechanism of action by inhibiting the transient outward current (Ito) and the repolarizing potassium currents in the sinoatrial node. Tedisamil works acutely against atrial fibrillation. Importantly, atrial fibrillation is often caused by or related to cardiac ischemia, and conversely, ischemia is caused by the increased oxygen demand of atrial fibrillation. Hence, the double properties of tedisamil as a drug that both inhibits atrial fibrillation and acts in an anti-ischemic mode are an attractive basis for future clinical research.

scholarly journals Interatrial block is related to atrial dysfunction in hypertensive subjects

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
L Tirapu Sola ◽  
F Loncaric ◽  
M Mimbrero ◽  
LG Mendieta ◽  
L Nunno ◽  
...  
Keyword(s):  
Global Longitudinal Strain ◽  
Female Gender ◽  
Left Ventricular ◽  
P Wave ◽  
P Value ◽  
Atrial Remodeling ◽  
Maximal Volume ◽  
Surface Ecg ◽  
Interatrial Block ◽  
And Function

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): La Marató TV3 Background Interatrial block (IAB), a delay of conduction of the sinus stimulus from right to left atria (LA), is defined as surface ECG P-wave duration ≥120 ms. Arterial hypertension (AH) and IAB have been related to development of atrial fibrillation. Aim To investigate the IAB prevalence in a cohort of AH patients and relate it to LA function. Methods 162 patients with well-regulated AT were included. 12-lead ECG were performed and analysed with a digital caliper. 2D and 3D echocardiography were performed, and LA function assessed with speckle-tracking deformation imaging.  Results The median age was 56 ± 6 years, 54% were males. Average duration of AH was 10 ± 6 years. IAB was seen in 25% of AH patients.  The comparison between groups is shown in Table 1. There were no differences in demographic characteristics,  QRS complex duration (p = 0.179) or left ventricular (LV) size and function between subgroups. LA was enlarged in IAB patients, which was coupled with impairment of the LA reservoir strain.  Conclusion Our results show considerable prevalence of IAB in AH patients. The demonstrated LA enlargement and function impairment is not associated with LV dysfunction, therefore suggesting an independent role of IAB in atrial remodeling. Table 1 Interatrial block P value Yes (n= 40) No (n= 142) Age 59 (54-62) 57 (53-61) 0.157 Female gender 16 (40%) 58 (48%) 0.467 Duration of Hypertension (years) 10 (6-12) 8 (5-15) 0.421 Systolic blood pressure (mmHg) 136 (125-150) 136 (127-147) 0.799 Diabetes 3 (8%) 16 (13%) 0.410 LVEDV (mL) 73 (63-91) 71 (57-87) 0.424 E/A 0.98 (0.84-1.25) 0.94 (0.79-1.11) 0.230 E/e’ 7.0 (4.9-8.9) 6.6 (5.2-8.4) 0.779 LVEF (%) 63 ± 7 64 ± 6 0.864 LV global longitudinal strain (%) 21.22 ± 2.63 21.19 ± 2.30 0.932 3D LA maximal volume (mL/m2) 36 (30-39) 30 (26-37) 0.028 3D LA minimal volume (mL/m2) 16 (12-18) 14 (11-17) 0.050 LA reservoir strain (%) 27.64 (24.90-31.23) 29.55 (26.17-32.81) 0.032 LA conduit strain (%) 13.91 (10.71-15.47) 14.37 (11.75-16.72) 0.192 LA contractile strain (%) 14.46 (11.86-16.59) 15.52 (13.66-16.96) 0.079 LVEDV Left Ventricular End Dyastolic Volume

P Wave Dispersion in Hypertensive Patients with Paroxysmal Atrial Fibrillation

2000 ◽  
Vol 23 (11P2) ◽  
pp. 1859-1862 ◽  
Author(s):  
NECLA ÖZER ◽  
KUDRET AYTEMIR ◽  
ENVER ATALAR ◽  
ELIF SADE ◽  
SERDAR AKSÖYEK ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Wave Dispersion ◽  
P Wave ◽  
P Wave Dispersion ◽  
Hypertensive Patients

Abstract 2155: Plasma Adiponectin Levels in Patients with Atrial Fibrillation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Masayuki Shimano ◽  
Rei Shibata ◽  
Yukiomi Tsuji ◽  
Noriyuki Ouchi ◽  
Yasuya Inden ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Collagen Type ◽  
Collagen Type I ◽  
High Plasma ◽  
P Wave ◽  
Atrial Remodeling ◽  
Type I ◽  
Plasma Adiponectin ◽  
Type Iii ◽  
And Control

The occurrence and development of atrial fibrillation (AF) are associated with changes in electrical properties and cardiac structure, known as electrical and structural atrial remodeling. AF characterized by atrial remodeling also occurs with obesity-related conditions. Adiponectin, an adipose tissue-derived hormone, exerts beneficial effects on the heart in various pathological conditions. These observations led us to speculate that adiponectin levels affect the development and prevalence of AF. Here, we investigated a potential association between circulating adiponectin levels and atrial remodeling in patients with AF. We measured plasma adiponectin levels, serum carboxy-terminal telopeptide of collagen type I (CITP) levels, as a collagen type I degradation marker, and serum type III procollagen-N-peptide (PIIINP) levels, as a collagen type III synthesis marker in consecutive 414 patients; 225 paroxysmal AF, 81 persistent AF and 108 paroxysmal supra-ventricular tachycardia without AF history (control) patients, who admitted for scheduled radiofrequency catheter ablation. Plasma adiponectin levels were significantly higher in patients with persistent AF compared to paroxysmal AF and control patients (p<0.05). Serum CITP levels, but not serum PIIINP levels, were also higher in patients with persistent AF compared to paroxysmal AF and control patients (p<0.05). In addition, a positive correlation was observed between adiponectin levels and CITP levels (r=0.39, p<0.005) or the P wave duration (r=−0.31, p<0.05) in patients with persistent AF. High plasma adiponectin levels are associated with the presence of persistent AF, which is accompanied by increased CITP levels. Hyperadiponectinemia might also attenuate atrial conduction disturbance. Thus, measurement of plasma adiponectin could be useful for assessment of AF.

scholarly journals Echocardiography in Patients with Atrial Fibrillation - What Should the Internist Doctor Know?

2020 ◽  
Vol 17 (4) ◽  
pp. 49-60
Author(s):  
Maria-Luiza Toplicianu-Dimitriu ◽  
Ioan Tiberiu Nanea
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Structural Changes ◽  
Excess Mortality ◽  
Ventricular Dysfunction ◽  
Imaging Technique ◽  
Left Ventricular ◽  
Clinical Impact ◽  
Atrial Remodeling ◽  
Routine Imaging

AbstractAtrial fibrillation (AF) is the most common cardiac arrhythmia, with an increasing prevalence and an enormous clinical impact due to the high stroke rate, left ventricular dysfunction and excess mortality. The occurrence and maintenance of AF is favored by both the degree of left atrial (LA) dilation and the association of fibrotic lesions of the myocardium. The LA is a marker of adverse cardiovascular events in patients with AF. Atrial remodeling can be electrical (shortening atrial refractory), structural (altering geometry and altering collagen content) and contractile (loss of contractility). Cardiac imaging plays a central role in the clinical management of this arrhythmia. Echocardiography represents the routine imaging technique used in patients with AF, with a role in detecting LA dysfunction and cardiac structural changes that predispose to this arrhythmia, also having the ability to predict the maintenance of sinus rhythm after cardioversion and after ablation.

Abstract 2023: Effect Of Chronic Stretch Reversal On Atrial Remodeling In Humans: Implications For The Atrial Fibrillation Substrate

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Bobby John ◽  
Martin K Stiles ◽  
Sunil T Chandy ◽  
Pawel K Kuklik ◽  
Glenn D Young ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Important Determinant ◽  
P Wave ◽  
Atrial Remodeling ◽  
Conduction Time ◽  
Atrial Arrhythmias ◽  
Wave Duration ◽  
P Wave Duration ◽  
Before And After ◽  
Mitral Commissurotomy

Background : Chronic atrial stretch is an important determinant for atrial fibrillation (AF). Whether relief of stretch reverses the substrate predisposed to AF is unknown. Methods: Twenty one pts (31±9 years) with mitral stenosis (MS; MVA 0.89±0.1cm 2 ) undergoing mitral commissurotomy (MC) were studied by electrophysiological or electroanatomical mapping of both atria before and after MC. Multipolar catheters were placed in the lateral RA, Crista (CT), coronary sinus (CS), septal RA and LA. We measured: effective refractory period (ERP) at the LA appendage, septal/lateral LA roof, posterior LA, inferior LA, proximal/distal CS, low/high LRA and SRA at 600 and 450ms; P wave duration (PWD); double potentials (DP) or fractionated signals (FS) along CT; and conduction time along CS, LRA, inferior LA and LA roof. Activation and voltage maps were created to evaluate changes in conduction and voltage. In 14 pts, RA studies were repeated ≥6 months after MC. Results : Following MC, there was significant increase in MVA (2.1±0.3 cm 2, p<0.0001) with decrease in LA (23±8 to 10±4 mmHg, p<0.0001) and PA pressures (38±17 to 27±14mmHg, p<0.0001) and LA volume (75±12 to 52±13ml, p<0.0001). This was associated with no change in ERP and No. of DP/FS along the CT but with reduction in PWD (139±19 to 135±20ms, p=0.047), increase in conduction velocity (CV) in LA (1.3±0.3 to 1.7±0.2m/s, p=0.005) and RA (1.0±0.1 to 1.3±0.3 m/s, p=0.007) and increase in LA voltage (1.7±0.6 to 2.5±1.0 mV, p=0.05). Late after MC, there was a further decrease in PWD and RA ERP, with increase in RA CV (1.0±0.1 to 1.3±0.2 m/s, p=0.01) and voltage (1.7±0.7 to 2.8±0.6 mV, p=0.004) but with no change in other parameters. See table for details of pts studied late after MC. Conclusion: The electrophysiologic and electroanatomic abnormalities within the atria that result from MS are reversed after MC. These observations suggest that the substrate predisposing to atrial arrhythmias may be reversed. Results

Abstract 14614: The Automatically Assessed P-wave Notch Predicts Cardiovascular Events in Patients With Cardiovascular Risks: The Japan Morning Surge Home Blood Pressure (J-HOP) Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tomoyuki Kabutoya ◽  
Satoshi Hoshide ◽  
Kazuomi Kario
Keyword(s):  
Left Atrial ◽  
Cardiovascular Events ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
P Wave ◽  
Control Group ◽  
Atrial Remodeling ◽  
Wave Group ◽  
Left Atrial Diameter ◽  
Wave Characteristics

Background: The notched P-wave characteristics is associated with atrial remodeling. However, the relationship between notched P-wave characteristics and long-term cardiovascular events remains unclear. Hypothesis: We hypothesized that the notched P-wave would be associated with cardiovascular events. Methods: We enrolled 810 subjects from the J-HOP Study who had ≥1 of four cardiovascular risk factors. Twelve-lead electrocardiography was conducted, and the peak-to-peak distance in the M-shape was calculated automatically using a 12-lead ECG Analysis system (Fukuda Denshi, Tokyo). We compared two definitions: P waves were defined as "notched" if the peak-to-peak distance in the M-shape was ≥20 msec or ≥40 msec in lead II. The primary endpoints were fatal/nonfatal cardiovascular events: myocardial infarction, stroke, hospitalization for heart failure, and aortic dissection. We assessed the left atrial diameter and left ventricular mass index (LVMI) by echocardiography. Results: The mean follow-up period was 101±34 months, and 85 cardiovascular events occurred. When we defined a notched P wave as ≥20msec in the M shape (n=92), a notched P wave was a significant predictor of cardiovascular events after adjustment for age, gender, and comorbidity (hazard ratio 1.80, 95%CI: 1.06-3.05). When we defined a notched P wave as ≥40msec in the M shape (n=25), the hazard ratio of cardiovascular events in the notched P-wave group was significantly borderline after adjustment for covariates (hazard ratio 2.23, 95%CI: 0.90-5.56). The left atrial diameter and LVMI in the patients in the notched P-wave group (≥20 msec in the M shape) were significantly higher than those in the control group (left atrial dia. 38.8±5.9 vs. 36.8±5.0 mm, p=0.001; LVMI 103.9±27.7 vs. 96.3±25.7 g/m 2 , p=0.010). Conclusion: The automatically assessed notched P wave was associated with cardiovascular events, left atrial enlargement and left ventricular hypertrophy.

scholarly journals Atrial Fibrillation Progression Is Associated with Cell Senescence Burden as Determined by p53 and p16 Expression

2019 ◽  
Vol 9 (1) ◽  
pp. 36
Author(s):  
Laurence Jesel ◽  
Malak Abbas ◽  
Sin-Hee Park ◽  
Kensuke Matsushita ◽  
Michel Kindo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Right Atrial ◽  
Atrial Remodeling ◽  
Inflammatory Proteins ◽  
Underlying Mechanisms ◽  
The Right ◽  
New Evidence

Background: Whilst the link between aging and thrombogenicity in atrial fibrillation (AF) is well established, the cellular underlying mechanisms are unknown. In AF, the role of senescence in tissue remodeling and prothrombotic state remains unclear. Aims: We investigated the link between AF and senescence by comparing the expression of senescence markers (p53 and p16), with prothrombotic and inflammatory proteins in right atrial appendages from patients in AF and sinus rhythm (SR). Methods: The right atrial appendages of 147 patients undergoing open-heart surgery were harvested. Twenty-one non-valvular AF patients, including paroxysmal (PAF) or permanent AF (PmAF), were matched with 21 SR patients according to CHA2DS2-VASc score and treatment. Protein expression was assessed by tissue lysates Western blot analysis. Results: The expression of p53, p16, and tissue factor (TF) was significantly increased in AF compared to SR (0.91 ± 0.31 vs. 0.58 ± 0.31, p = 0.001; 0.76 ± 0.32 vs. 0.35 ± 0.18, p = 0.0001; 0.88 ± 0.32 vs. 0.68 ± 0.29, p = 0.045, respectively). Expression of endothelial NO synthase (eNOS) was lower in AF (0.25 ± 0.15 vs. 0.35 ± 0.12, p = 0.023). There was a stepwise increase of p53, p16, TF, matrix metalloproteinase-9, and an eNOS progressive decrease between SR, PAF, and PmAF. AF was the only predictive factor of p53 and p16 elevation in multivariate analysis. Conclusions: The study brought new evidence indicating that AF progression is strongly related to human atrial senescence burden and points at a link between senescence, thrombogenicity, endothelial dysfunction and atrial remodeling.

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